S297 Effectiveness and Safety of Thin vs Thick Cold Snare Polypectomy of Colorectal Polyps: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
Introduction: Cold-snare polypectomy (CSP) is considered the standard of care for resection of colorectal polyps ≤ 10mm. Data on the efficacy of CSP performed with thin-wire snares compared to thick-wire snares are conflicting. We performed a meta-analysis comparing complete resection (CR) and adverse event rates of CSP using thin-wire and thick-wire snares. Methods: Comparative studies of adult patients with ³1 colorectal polyp(s) £10 mm who underwent CSP with thin-wire or thick-wire snares were included. We collected data on study, patient, polyp, and snare characteristics. The primary outcome was CR rate. Secondary outcomes were polyp retrieval rate, intraprocedural bleeding, delayed post-polypectomy bleeding, deep mural injury or perforation, patient discomfort, total sedation, and procedure time. We used random-effects models to calculate risk ratios for outcomes. We performed risk of bias assessments, rated the certainty of evidence, and assessed publication bias for all studies. Results: We included 4 randomized controlled trials (RCTs) and 2 observational studies including 1316 patients with 1679 polyps (826 thin-wire CSPs and 853 thick-wire CSPs). There was no significant difference between groups regarding CR rate for RCTs (92.1% versus 87.7%, RR 1.05, 95% CI 0.94-1.16) or observational studies (78.1% versus 79.6%, RR 1.03, 95% CI 0.99-1.08). There were no significant differences in polyp retrieval rate or intraprocedural bleeding. There were no cases of delayed bleeding or perforation (Figure 1, Table 1). Conclusion: We found no differences in CR rates for CSP between thin-wire and thick-wire snares. CSP, regardless of snare type, is safe and effective for resection of small colorectal polyps. Table 1. - Certainty assessment N Effect Certainty No of studies Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations Thin-wire snare Thick-wire snare Relative (95% CI) Absolute (95% CI) Complete resection rate 4 randomised trials not serious seriousa not serious not serious none 563/611 (92.1%) 533/608 (87.7%) RR 1.05(0.94 to 1.16) 44 more per 1,000(from 53 fewer to 140 more) ⨁⨁⨁◯Moderate Polyp retrieval rate 3 randomised trials very seriousb not serious not serious not serious none 513/513 (100.0%) 495/496 (99.8%) RR 1.00(1.00 to 1.01) 0 fewer per 1,000(from 0 fewer to 10 more) ⨁⨁◯◯Low Intraprocedural bleeding 4 randomised trials not serious not serious not serious very seriousc None 17/550 (3.1%) 13/535 (2.4%) RR 1.28(0.51 to 3.20) 7 more per 1,000(from 12 fewer to 53 more) ⨁⨁◯◯Low CI: confidence interval; RR: risk ratio a. One study which favours thick-wire snare, one study which favours thin-wire snare, and 2 studies found no difference between thin-wire snare and thick-wire snare b. Endoscopist participants in all studies were not blinded to group. c. Few events of intraprocedural bleeding and very wide confidence intervals. Figure 1.: Forest plots of primary and secondary outcomes. A: complete resection rate for randomized trials; B: complete resection rate for observational studies; C: polyp retrieval rate for randomized trials; D: polyp retrieval rate for observational studies; E: intraprocedural bleeding for randomized trials; F: intraprocedural bleeding for observational studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.033 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.032 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".